RN Case Manager/UT Review

Susan B Allen Memorial Hospital•El Dorado, KS

About The Position

This role is responsible for managing patients within the skilled care program, ensuring they meet qualifications, facilitating necessary documentation, and coordinating care. The position involves maintaining patient records, completing assessments like the RAI-MDS, supervising activities programs, and collaborating with various departments including Utilization Review, Social Work, and the Discharge Planning Team. The RN Case Manager will also serve as a liaison between patients, families, physicians, and staff, ensuring effective communication and adherence to CMS regulations and reimbursement requirements. Additionally, the role requires participation in quality assurance activities and continuing education to stay current with program regulations and best practices.

Requirements

Graduate of a State Board approved or accredited school of nursing.
Must possess evidence of current Kansas license or valid temporary permit to practice (if coming from out of state).
Must be certified as an Activity Director from KDHE approved program within 6 months of start date.
A minimum training level of BLS is required.
Will be orientated to and maintain competence in working with adult and geriatric patients.
Competence at the beginning of employment will be measured through observation during orientation, math and medication administration testing, and review of documentation.
Ongoing competence will be measured through observation of clinical practice, observation for performance evaluation, competency inservice and testing, and math and medication administration testing.

Nice To Haves

BSN preferred.
Prefer a minimum of two (2) years of recent Resident Assessment Instrument Minimum Data Set (RAI-MDS) experience (within the past 5 years).
Prefer experience with and knowledge of current CMS regulations.

Responsibilities

Ensure appropriate patients are admitted to the skilled care program by working with UR, SW, and Department Director to identify candidates, verify qualifications, facilitate HINN issuance, discuss level of care changes, and obtain physician orders and certifications.
Maintain patient census log for the skilled care program, including records of all screened and admitted patients.
Facilitate assessment of all patients admitted to the skilled care program.
Complete the Resident Assessment Instrument Minimum Data Set (RAI-MDS) according to Medicare schedule for Skilled Care.
Supervise and coordinate the Activities Program for Skilled Care/Swing Bed patients.
Perform the Essential Functions of the Nursing Activity Clerk.
Meet CMS requirements for initiating, updating, and maintaining the care plan.
Maintain knowledge about state-required assessments, including requirements on completion of the MDS, according to defined coding to ensure proper reimbursement for care.
Assist the Discharge Planning Team in reviewing patient goals; revise and complete goals as appropriate.
Facilitate interdisciplinary care for patients in the Skilled Care Program.
Attend and participate in Discharge Planning Team meetings.
Document patient information in the Electronic Medical Record.
Participate in quality assurance, assessment and improvement activities.
Maintain current knowledge of the Skilled Care Program and regulations that apply to patient care, reimbursement, and surveys.
Utilize and attend skilled care continuing education when possible.
Serve as a liaison between patients, families, physicians, management and staff.
Communicate regularly with director, staff and physicians.
Communicate the Resource Utilization Group (RUG) category and other clinical information needed to process claims.
Maintain log of RUG categories and services that are excluded from consolidated billing.
Submit information to the business office for timely billing of the skilled care claim.
Involve patient and families in the plan of care by discussing that plan with them.
Invite patients and/or families to care planning meetings as appropriate.
Review all care plans and goals with patients or families that did not attend care plan meeting.
Ensure patient information is shared with appropriate disciplines.
Collaborate with and assist the Social Work department in the Discharge Planning Process.
Ensure the discharge plan is initiated and is revised according to patient progress; verify the patient/family is informed of discharge plans; verify postdischarge care needs are identified and addressed.
Serve as a resource for the patient, family and physician.
Meet with patient, family and physicians as needed to address issues that arise.
Collaborate with and assist Utilization Review Nurses.
Perform other duties as assigned.
Perform the Essential Functions of Ward Clerk.
Perform the Essential Functions of Staff Registered Nurse.